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OMS - 2 Neuro Final > Anti-Epileptics > Flashcards

Anti-Epileptics Flashcards

1
Q

Classification of seizure types

A
  1. Focal
  2. Generalize
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2
Q

Epilepsy: etiology

A
  1. Structural (neurologic defect)
  2. Genetic
  3. Infectious
  4. Immune
  5. Metabolism
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3
Q

How is a seizure different from epilepsy

A
  • Seizure is an isolated incidents
  • 2 or more = epilsepsy

(certain drugs can cause a seizure, that doesn’t make an epilepsy diagnosis)

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4
Q

Focal seizure types

A
  1. Simple partial
  2. Complex partial
  3. Secondarily generalized (focal in one location → spreads to another part of the brain)
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5
Q

Generalized seizure types (5)

A
  1. Absence (petit mal - 15 sec)
  2. Atonic
  3. Tonic
  4. Tonic-clonic
  5. Myoclonic
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6
Q

Define myoclonic seizure

A
  • Synchronous jerks
  • Bilateral
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7
Q

Tonic clonic seizure characteristics

A

Convulsive seizure (aka Grand mal)

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8
Q

Atonic seizure

A

Fall to the ground

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9
Q

Choosing anti-epileptic drugs involves which factors (4)?

A
  1. Advanced Age, gender
  2. Epilepsy syndrome
  3. Related medical conditions (HIV- HAART therapy)
  4. Seizure type

(and … Efficacy, Side effects, Pharmacokinetics (may lead to toxicity)

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10
Q

Mono-therapy should be used until seizures are controlled or toxicity occurs.

If mono-therapy has reduced, but not eliminated seizures, what do you do?

A

Add another drug to the regimen rather than switching to a new drug

(caution: drug interaction and pregnancy!!)

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11
Q

Why can’t you just remove a drug from the patient’s regimen?

A

Tapering, otherwise → rebound seizures

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12
Q

Neuronal mechanism underlying seizures (3)

A
  1. Suppression of GABA (inhibitory)
  2. Increase in Ca2+ influx via T-Type Ca2+ channels in thalamic neurons
  3. Glutamate → activation of excitatory NTs

(spiklet causes the shift that leads to siezure→ stimulates other parts of the brain)

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13
Q

Adverse effects of anti-seizure drugs

A
  1. Suicide
  2. Multi-organ hypersensitivity reactions (can be fatal)

(certain populations are more sensitive)

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14
Q

Action potential mechanism of action

A
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15
Q

Antiepileptic drugs: 3 MOAs

A
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16
Q

Phenytoin:

  • MOA
  • Indications
A
  • Blocks voltage-gated sodium channels
  • Focal seizures, Tonic-clonic seizures, Status epilepticus
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17
Q

Limitations of use for phenytoin

A

Metabolized by the liver under polygenic control which varies between patients

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18
Q

Define dose-dependent kinetics

A
  1. Lower concentrations are eliminated by first order kinetics
  2. Higher concentrations saturate biotransformation enzymes and inhibit zero order kinetics
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19
Q

Phenytoin interaction induces which enzyme systems?

A
  1. CYP2C
  2. CYP3A
  3. UGT

(pronounced “sip-2-C”; This accelerates metabolism of other drugs)

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20
Q

Phenytoin side effects (5)

A
  1. Nystagmus and ataxia in elderly
  2. Gingival hyperplasia
  3. Neuropathy and osteoporosis (long term use)
  4. Interferes with folate metabolism (megaloblastic anemia & fetal hydantoin syndrome)
  5. SJS & TEN linked to polymorphism in HLA allele (small population)
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21
Q

Carbamazepine and oxcarbazepine indications

A

Focal seizures and generalized tonic-clonic seizures

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22
Q

Carbamazepine and oxcarbazepine mechanism of action

A

Inhibits generation of repetitive action potentials in the epileptic focus and prevents their spread

(activates its own metabolism)

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23
Q

Oxcarbazepine has a lower risk for ________, but a higher risk for ______.

A
  1. Lower risk for p450 enzymes inducer → Lower risk of rash
  2. Hyponatremia
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24
Q

Oxcarbazepine is converted to ______

A

Active metabolite

(blocks sodium channel and thought to modulate calcium channels)

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25
Q

Carbamazepine & Oxcarbazepine pharmacokinetics

A
  • active metabolite: carbamazepine epoxide induces its own metabolism and that of other drugs
  • Inducer of CYP & UDP enzymes
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26
Q

Lamotrigine MOA

A

Block sodium Channel and l-type calcium channels

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27
Q

Dosages of _____ should be reduced when adding to valproate therapy to reduce risk of SJS.

A

Lamotragine

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28
Q

Valproic acid mechanism of action

A

Block sodium and T-Type calcium channels

29
Q

Valproic acid indications

A
  1. Mixed seizure types
  2. Absence seizure that does not respond to ethosuximide
  3. alternative to phenytoin and carbamazepine for focal seizures

(2nd line)

30
Q

Valproic acid side effects (6)

A
  1. GI: transient anorexia, N/V
  2. Teratogenic effects
  3. Hyperammonia
  4. Hypersensitivity
  5. Inhibits metabolism of other drugs
  6. Hepatotoxicity

(high risk for congenital malformation for pregnant women)

31
Q

Ezogabine MOA

A

Opens potassium channels and stabilizes rester membrane potential to hyperpolarize the neuron

32
Q

Ezogabine uses

A

Treatment of seizures in children and adults with LGS

33
Q

Ezogabine side effects

A
  1. Blue skin discoloration
  2. Urinary retention
  3. Retinal abnormalities
34
Q

______ reduces propagation of abnormal electrical activity by inhibiting T-Type calcium channels

A

Ethosuximide

35
Q

Ethosuximide side effects (3)

A
  1. Dizziness
  2. Nausea
  3. Epigastric discomfort
36
Q

Ethosuximide interactions

A
  1. Valproate inhibits metabolism
  2. Haloperidol can alter seizure pattern
37
Q

Ethosuximide indications

A

absence seizures

(long half life 30 hours in children, 55 in adults)

38
Q

Gabapentin MOA (2)

A
  1. ⇡ release of GABA
  2. inhibits L-type Ca2+ channels (⇣ NT release)

(Analog of GABA; adjunct therapy for focal seizures; does NOT mimic GABA, acts at the channel)

39
Q

Vigabatrin MOA

A

Inhibits GABA metabolism

(gamma aminobutyric acid transaminase (GABA-T))

40
Q

Vigabatrin use

A

focal epilepsy

41
Q

Vigabatrin side effect

A

visual field loss

42
Q

Benzodiazepine MOA (2)

A
  1. Increases affinity of GABA for receptor
  2. enhances Cl- flux

(reserved for Emergent tx)

43
Q

Benzodiazepine is an adjunct treatment for :

A

focal & tonic-clonic seizures

(reserved for emergency or acute seizure due to tolerance)

44
Q

Benzodiazepines adverse effects (3)

A
  1. Dizziness
  2. Ataxia
  3. Drowsiness
45
Q

Which 2 benzodiazepine can be used for treating lennox-gastaut syndrome?

A

Clobazam & clonazepam

46
Q

Phenobarbital MOA (2)

A
  1. Enhances the inhibitory effects of GABA- mediated neurons
  2. Binds to allosteric sites

(second line focal seizures & tonic-clonic seizures)

47
Q

Primidone is metabolized into _____ & _____.

A
  • phenobarbitol
  • phenylethylmalonamide

(Both have anticonvulsant activity & block sodium channels and potentiate GABA)

48
Q

Hypersensitivity to barbiturates will develop as a

A

Rash

49
Q

Felbamate MOA

A

Blocking coactivation of the nmda receptor

50
Q

Felbamate indication

A

Partial seizures refractory to other drugs do to risk of aplastic anemia and hepatic failure

51
Q

Felbamate is an inhibitor of drugs metabolized by _____

A
  1. CYP2C19
  2. CYP3A4
52
Q

Rufinamide interactions

A
  1. induced by carbamazepine and phenytoin
  2. valproate inhibits
53
Q

Topiramate adverse effects

A
  1. cleft palate
  2. somnolence
  3. ataxia
  4. weight loss
  5. paresthesias
54
Q

Topiramate MOA

A

Blocks voltage-dependent sodium channels, glutamate receptors and augmentation of GABA

55
Q

Topiramate indications

A

Focal and primary generalized epilepsy

(Olek says myoclonic as well)

56
Q

Define status epilepticus

A
  • Two or more seizures occur without fully recovering Consciousness in between episodes
  • Life-threatening emergency: prolonged hypoxia→ severe brain damage
57
Q

Status epilepticus treatment

A
  1. Benzodiazepine followed by a slow-acting medication (phenytoin)
  2. phenobarbital if others fail
58
Q

________ (2) prefered rx for status epilepticus

A
  1. lorazapam
  2. diazepam
59
Q

Anti-epileptic medication contraindicated in pregnancy (2)

A
  1. Divalproex
  2. Barbiturates
  3. Phenytoin
  4. carbamazepine
  5. lamotrigine
  6. topiramate
  7. valproate (sometimes used if no other option)
60
Q

Rufinamide MOA

A

inhibits Na channels → inhibits mGluR5 (subset of glutamate receptors)

(inhibitos CYp2E1 & CYP3A4)

61
Q

Which meds treat tonic-clonic & partial seizures?

A
  1. Carbamazepine
  2. Phenytoin
  3. Valproate
62
Q

Which drug treats absence seizures in adults & which for children?

A
  • adults: valproate
  • children: ethosuximide
63
Q

Which drug treats myoclonic & atonic seizures?

A

valproate

64
Q

Which drugs treat status epilepticus?

A
  1. lorazepam
  2. diazepam
  3. phenytoina
65
Q

Lacosamide MOA

A

blocks voltage-gated Na+

66
Q

Lacosamide is indicated for _______ seizures

A

focal

67
Q

Dizziness, headache and fatigue are the adverse effects of which drug that treats focal seizures?

A

Lacosamide

68
Q

Dravet syndrome tx

A

stirpentol (GABA NT)

(more drug interactions)

OMS - 2 Neuro Final (36 decks)

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